Provider Demographics
NPI:1710070370
Name:THE PALMCREST GRAND CARE CENTER, INC.
Entity Type:Organization
Organization Name:THE PALMCREST GRAND CARE CENTER, INC.
Other - Org Name:THE PALMCREST GRAND CARE CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:562-595-1731
Mailing Address - Street 1:3501 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3809
Mailing Address - Country:US
Mailing Address - Phone:562-595-1731
Mailing Address - Fax:562-426-1099
Practice Address - Street 1:3501 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3809
Practice Address - Country:US
Practice Address - Phone:562-595-1731
Practice Address - Fax:562-426-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA940000130314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
056313Medicare Oscar/Certification
CA056313Medicare PIN